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Background and Aims Open cholecystectomy surgeries are one of the painful surgeries on the upper abdominal region that requires multimodal analgesia for rapid patient recovery. Though the gold standard is using ultrasound, when assigned in areas with austere set-up, knowing anatomic landmark techniques could benefit the patient. Local infiltration analgesia can be an alternative if the team does not know nerve block techniques. Combining anatomic landmark and the cocktail used for LIA is the basis of this report. 5 patients were enrolled during one of my surgical mission trip where ultrasound is not availavle in the hospital.Methods The patients were apprised and only those who consented were included. Patients were inducted under spinal anesthesia with 4cc of 0.5% Bupivacaine. Once returned to supine position, subcostal transabdominis plane along the anterior axillary line was identified using a 2.5 cm G23 syringe needle, 2 pops were noted from the external oblique and internal oblique fascial layer. LIA solution made of 20cc 0.3%ropivacaine with 30 mg ketorolac, 100 mg tramadol, 5 mg dexamethasone and 0.2 mg epinephrine was used for infiltration.Results Patients were assessed prior to discharge from the recovery room. None of the 5 patients complained of pain at PACU. 24 hours after surgery, patients were noted to be walking with no loss of appetite and analgesics taken were only oral paracetamol 1 gram every 8 hrs and celecoxib 200 mg every 12 hours. 48 hours after surgery, patient was already discharged well with controlled pain of 1–2.Conclusions In the absence of technology, our knowledge of nerve block techniques should allow us to give its benefits towards our patient. While having an ultrasound also should aide us in honing our skills in anatomic landmarking which is very helpful in time when technology fails or is absent.